AB1382 SCREENING OF INTERSTITIAL LUNG DISEASE IN PATIENTS WITH RHEUMATOID ARTHRITIS THROUGH AN ULTRASONOGRAPHY PROTOCOL
Authors: A. Brigante, J. Rebak, G. Rizzo, L. L. Holguín Arias, F. Rizzo, S. Quadrelli, D. Dubinsky
Journal: Annals of the Rheumatic Diseases (2022)

Background Interstitial Lung Disease (ILD) is a frequent complication in patients with autoimmune diseases. Rheumatoid arthritis (RA) does not escape this statement. Different protocols have been proposed for the ultrasound evaluation of this affectation showing very good correlation with high-resolution computed tomography. Objectives To determine the sensitivity and specificity of an ultrasound evaluation protocol as a screening method for interstitial lung disease in rheumatoid arthritis. Methods Consecutive patients diagnosed with RA, with and without ILD, will be included. High-resolution chest CT (HRCT) will be performed in all patients. The lung evaluation protocol by ultrasonography (US); evaluates 50 intercostal spaces (ICS) and will be performed by a rheumatologist and imaging specialist trained in the procedure. The presence of B lines and pleural alterations in the EICs explored will be evaluated. A semiquantitative scale will be used to assess each EIC: 0 = normal, (&lt;10 B lines); 1 = mild (11 to 20 B lines); 2 = moderate (21 to 50 B lines) and 3 = marked (&gt; 50 B lines). CT scan was considered the “gold standard” for the diagnosis of ILD and they were evaluated by experienced pulmonologists who were blind to the patient. Results 79 patients were included. Female sex 77% with a mean age of 55 (SD 11.4). The comorbidities observed were: hypertension 27%, dyslipidemia 15%, diabetes mellitus 10%, hypothyroidism 30%, smokers 14%, former smokers 18% and osteoporosis in 14% of patients. The patients had a median duration of the disease in years of 7.5 [IQR 9.2]. Erosive disease was seen in 20 (20%) and rheumatoid nodules in 9.1% of patients. 91% of the patients were under treatment with corticosteroids. Rheumatoid factor was observed in 87% of the patients and Anti-CCP in 71% of the patients, of which 70% had high titers. DILD was observed by HRCT in 21 (27%) patients. The tomographic patterns observed were UIP 7 (33%), probable UIP 2 (10%), cellular NSIP 6 (29%), fibrosing NSIP 3 (14%). An indeterminate pattern was observed in 3 patients. The extent of pulmonary involvement was extensive in 48% of patients and limited in 52%. A sensitivity of 63% (CI95% 44-78) and a specificity of 92% (CI95% 81-97) were observed for the ultrasound evaluation protocol with a PPV of 81% (CI95% 61-92) and NPV of 83 % (95% CI 71-90) and an LR+ 8.1 (95% CI 4.6-14.3) and LR- 0.4 (95% CI 0.3-0.48). AUC: 0.81 (p&lt;0.0001). Conclusion We observed a moderate sensitivity and specificity of the method to assess interstitial lung involvement in RA with an acceptable AUC for a screening method. These findings are similar to what was found in other cohorts. We observe a high NPV. This means that in patients with a negative study result, the possibility of ILD would be removed. Studies in larger cohorts and comparison with other factors associated with ILD are necessary to improve our understanding of the method and give it the place it deserves. References [1]Spagnolo P. et al. The Lung in Rheumatoid Arthritis ARTHRITIS &amp; RHEUMATOLOGY Vol. 70, No. 10, 2018, pp 1544–1554 [2]Barskova T. et al. Lung ultrasound for the screening of interstitial lung disease in very early systemic sclerosis. Ann Rheum Dis 2013;72:390–395. [3]GUTIERREZ M, SALAFFI F, CAROTTI M et al .: Utility of a simplified ultrasound assessment to assess interstitial pulmonary fibrosis in connective tissue disorders – preliminary results. Arthritis Res Ther 2011; 13: R134. [4]Cazenave T. et al. EVALUACIÓN DE PARÉNQUIMA PULMONAR Y LINEA PLEURAL POR ULTRASONOGRAFÍA: GRADO DE ACUERDO ENTRE OBSERVADORES ARGENTINOS. 53° Congreso de Reumatología.Salta. 2020. Disclosure of Interests None declared